For six years, researchers at the Hospital das Clínicas at the University São Paulo School of Medicine have been developing the autopsy technique, which includes the use of protective equipment similar to that used by health workers during Africa’s Ebola outbreaks.

“We plan to create a biological repository of tissue samples for use by researchers who want to understand the virus’s mechanisms of infection and help improve the diagnosis.”

Paulo Saldiva - School of Medicine, University of São Paulo.

The equipment “takes almost 30 minutes for the workers to put on”, Paulo Saldiva, professor of pathology at the School of Medicine and developer of the procedure, tells SciDev.Net.

The bodies are then wrapped in a protective, transparent plastic, and pathologists use an ultrasound device to locate the organs they want to analyse — primarily the lungs — and injecting needles through the plastic.

The needles have small openings, allowing researchers to extract tissue samples from the target organs.

“It replaces the need for extracting organs and ensures the protection of the specialists involved in the necropsy process, preventing any contact with the corpse,” Saldiva explains.

The tissue samples collected from suspected COVID-19 patients may be used to develop biological knowledge of the disease.

“We plan to create a biological repository of tissue samples for use by researchers who want to understand the virus’s mechanisms of infection and help improve the diagnosis,” Saldiva says. Samples are being collected from the brain, heart, lung, spleen, intestine and testicles, as well as salivary glands.

Although the equipment is not expensive, the technique requires training. Brazil’s Ministry of Health has advised medical staff not to perform autopsies of confirmed COVID-19 cases because of the high risk of contamination due to lack of adequate equipment.

The University of São Paulo School of Medicine had to adapt part of the Autopsy Room Imaging Platform, a 500 square meter, high-tech underground laboratory, to meet sanitary requirements and avoid the risk of contamination to researchers.

The state of São Paulo has the highest number of COVID-19 cases and deaths in Brazil.

Saldiva and his team began developing the autopsy technique in 2013, under a research project aimed at using modern autopsy techniques to investigate human diseases — primarily infectious diseases, but also those due to urban pollution — and to evaluate clinical diagnoses and treatment options.

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“The main advantage of the techniques by Saldiva and his team is to mitigate the risk of contamination by SARS-CoV-2 in professionals who perform the necropsy,” says Marco Aurélio Guimarães, a physiologist responsible for the Laboratory of Forensic Anthropology at the Ribeirão Preto Medical School.

But the main challenge is to share these techniques with other autopsy rooms in Brazil, which struggle with the lack of essential items, such as masks.

“It takes about 20 days to train a professional to perform these minimally invasive necropsy techniques,” Guimarães says.

“It is not much time, but given the current pandemic situation, it may be a complicating factor.”

The research project lead by Paulo Saldiva is funded by FAPESP, a donor of SciDev.Net